臺灣博碩士論文加值系統

目的：本研究之目的為探討美尼爾氏症病患在接受中耳注射高劑量慶大黴素治療後，在短期二年及長期平均十年追蹤對於眩暈狀況及生活功能有無改善；聽力是否因注射慶大黴素而改變；並使用適合問卷，以量化病患治療後之生活品質。
材料與方法：參與研究對象為1994-2002年在台北馬偕醫院，確定診斷為美尼爾氏症之病患14名，男性6名女性8名，平均年齡為48歲，並以中耳注射高劑量慶大黴素作為治療方法。其治療後之療效評估工具為美國耳鼻喉頭頸外科學會1995建立之「美尼爾氏症療效評估標準分級指南」，在短期二年及長期平均十年追蹤下，評估其眩暈的控制級數 (A - F) 、生活功能能力分級 (FL 1 - 5) 及聽力狀況 (stage1 - stage 4) 之變化。另外，使用Glasgow benefit inventory (GBI)問卷，評估個案治療後生活品質在一般性、社交及生理方面問題。
研究結果：眩暈狀況在短期二年追蹤，控制率為92.9% (A + B)，長期平均十年追蹤，控制率略為下降至85.7% (A + B)。生活功能能力在短期及長期追蹤，未達統計顯著差異，但有13名個案生活功能能力都較治療前好。在短期追蹤，聽力平均變差13.1dB，達統計顯著差異，在長期追蹤，聽力平均變差20.3dB，亦達統計顯著差異。生活品質問卷Glasgow benefit inventory (GBI)填答，顯示眩暈控制、生活功能能力以及聽力閾值較佳者，在面對生活中一般性問題及生理方面問題皆較好之趨勢，唯未達統計上顯著差異。
結論：美尼爾氏症病患在接受中耳注射慶大黴素治療後，在短期二年追蹤有92%長期平均十年追蹤有85.7% 的病患眩暈狀況可有效控制，生活功能能力分級亦有改善趨勢。在GBI問卷填答則顯示生活品質有改善之趨勢。在短期追蹤，聽力變差有4人(30.8 %)，在長期追蹤聽力變差有8人(61.5%)。使用高劑量慶大黴素治療美尼爾氏症雖可有效控制眩暈的狀況，改善生活品質，但仍存有耳毒性所致的聽力損失風險。

Objective: The aims of this study were to analyze the long-term results of vertigo control and changes in hearing sensitivity of patients who received high-dose intratympanic gentamicin instillation for refractory Meniere’s disease. A questionnaire were utilized to evaluate changes in quality of life as a result of intervention.
Materials and methods: Fourteen patients underwent fixed high dose intratympanic gentamicin injection at Mackay Memorial Hospital from 1994 to 2002 participated in this study. The 1995 American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) criteria for reporting the treatment outcome for Meniere’s Disease were used to assess the results. Vertigo control, functional level, and hearing thresholds of the patients were analyzed, respectively. The Glasgow benefit inventory (GBI) questionnaire was used to measure quality of life in three domains: social, general and physical.
Results: The overall successful vertigo control rate was 92.9% (class A+B) over the 2-year follow-up and 85.7% (class A+B) at long-term follow-up (average 10 years). Hearing level as pure-tone average deteriorated by 13.1 dB after 2 years follow-up and deteriorated by 20.3 dB after long-term follow-up, respectively. There was no significant difference in functional level between before treatment and after treatment at short- term and long-term follow ups. The mean total score of Glasgow benefit inventory was 33.5. This finding suggest that there were improvement in overall quality of life of patients after treatment. Patients who experienced good vertigo control, improved functional level as well as improved hearing threshold exhibited higher GBI scores in general and physical health subscales.

Conclusions: Administration of high-dose intratympanic gentamicin for refractory Meniere’s disease appeared to be effective in achieving long-term control of vertigo. It improved the life quality and functional level of patients with Meniere’s disease. The hearing thresholds deteriorated in 4 patients over the 2-year follow-up and 8 patients at long-term follow-up. The use of high-dose gentamicin treatment of Meniere's disease can be effective control vertigo, improve quality of life. However, the risk of ototoxicity to patients should be considered.

致 謝 I
中文摘要 II
英文摘要 IV
目 錄 VI
表目次 VIII
圖目次 IX
附錄目次 X
第一章 文獻探討 1
第一節 美尼爾氏症之診斷 1
第二節 美尼爾氏症之治療 5
第三節 中耳注射慶大黴素對眩暈的控制與聽力改變 7
第四節 美尼爾氏症治療效果評估 10
第五節 研究目的 13
第二章 研究方法 14
第一節 研究架構 14
第二節 研究對象 16
第三節 研究工具 17
第四節 研究流程 21
第五節 資料分析 23
第三章 研究結果 24
第一節 治療結果之研究 24
第二節 治療後生活品質問卷研究結果 31
第四章 討論 35
第五章 結論 40
參考文獻 42

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